New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/25/2024 1:24:00 PM
Cost:
50
Service:
Change Lenses
prescribed by doctor:
Notes:
OLD Degrees + AR Transition
SPH
CYL
AX
ADD
OD
-0.5
1
15
OS
-0.75
1
167
Date of visit:
5/21/2025 3:49:00 PM
Cost:
50
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
AR + transition
SPH
CYL
AX
ADD
OD
-0.5
1
15
OS
-0.75
1
167
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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